Tran Bach Xuan, Nguyen Long Hoang, Tran Tung Thanh, Latkin Carl A
Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam.
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
PLoS One. 2018 Jan 18;13(1):e0190941. doi: 10.1371/journal.pone.0190941. eCollection 2018.
Methadone maintenance treatment (MMT) services may reduce the risk of HIV transmission if patients completely adhere to the treatment. Identifying adherence patterns and potential related factors is vital for the sustainability of MMT program in Vietnam. This study examined social and structural factors associated with adherence to MMT among patients in different service delivery models.
A total of 510 patients at three MMT clinics in Hanoi were interviewed. Measures of self-reported adherence included the number of missed doses in the past 7 days and the level of adherence in the past 30 days using a visual analog scale (VAS) scoring from 0 (non-adherence) to 100 (perfect adherence). Multivariate regressions were employed to identify factors associated with non-adherence to MMT.
A total of 17.7% of participants reported incomplete MMT adherence in the last 30 days and 8.3% reported missing a dose in the last seven days, respectively. Living with HIV/AIDS, poor self-care and usual activities, and disclosure of health issues to spouses or intimate partners were associated with non-adherence. Those patients with pain or depression were more likely to report better adherence. Disclosing health status to spouse/partner increased the risk of incomplete adherence, while disclosing to friends reduced the number of missed dose in the last seven days. Patients attending clinics with comprehensive services had a lower VAS score of adherence compared to those enrolling in clinics with only MMT and general health care.
Sustaining the compliance of patients to MMT is principal in the rapid expansion of this service in Vietnam. It is necessary to address the complexity of health care demands of drug users, their difficulties to be rehabilitated into workforce and society, and the stigmatization to maximize the outcomes of MMT program.
如果患者完全坚持美沙酮维持治疗（MMT）服务，可能会降低艾滋病毒传播风险。识别坚持模式和潜在相关因素对于越南MMT项目的可持续性至关重要。本研究调查了不同服务提供模式下患者坚持MMT的社会和结构因素。
对河内三家MMT诊所的510名患者进行了访谈。自我报告的坚持措施包括过去7天错过的剂量数，以及使用视觉模拟量表（VAS）在过去30天的坚持水平，VAS评分从0（不坚持）到100（完全坚持）。采用多变量回归来识别与不坚持MMT相关的因素。
分别有17.7%的参与者报告在过去30天内MMT坚持不完全，8.3%的参与者报告在过去七天内错过一剂。感染艾滋病毒/艾滋病、自我护理和日常活动较差以及向配偶或亲密伴侣披露健康问题与不坚持有关。那些有疼痛或抑郁的患者更有可能报告坚持情况较好。向配偶/伴侣披露健康状况会增加不完全坚持的风险，而向朋友披露则会减少过去七天内错过的剂量数。与仅接受MMT和一般医疗服务的诊所的患者相比，在提供综合服务的诊所就诊的患者VAS坚持评分较低。
在越南迅速扩大这项服务的过程中，维持患者对MMT的依从性是首要任务。有必要解决吸毒者医疗保健需求的复杂性、他们重新融入劳动力市场和社会的困难以及污名化问题，以最大限度地提高MMT项目的效果。
